Provider Demographics
NPI:1629077029
Name:ELASHI, ESSAM BASHIR (MD)
Entity Type:Individual
Prefix:
First Name:ESSAM
Middle Name:BASHIR
Last Name:ELASHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1031 PIERCE STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870
Mailing Address - Country:US
Mailing Address - Phone:419-557-5541
Mailing Address - Fax:419-557-5542
Practice Address - Street 1:1221 HAYES AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3345
Practice Address - Country:US
Practice Address - Phone:419-627-8403
Practice Address - Fax:419-627-1962
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2015-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35072580207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000129589OtherANTHEM BC/BS
OH110207740OtherRAILROAD MEDICARE
OH2211547Medicaid
OHEL4023311Medicare PIN
H17525Medicare UPIN